The Madras Medical College and its affiliated Government General Hospital, Chennai, are among the oldest medical institutions in India. The Madras Institute of Neurology (MIN) was the second neurosciences department to be started in India. The MIN has trained several batches of illustrious neurologists and neurosurgeons. This article briefly traces the history of the MIN, its important milestones, and its current developments.

Keywords: History of neurosciences in India; Madras Institute of Neurology; neuroscience training in India

The Madras Medical College (MMC) and the affiliated Government General Hospital, Chennai [Figure 1] and [Figure 2], are among the oldest premier medical institutions in this part of the world. The institution has various specialty and superspecialty departments providing state-of-the-art medical care to the needy community free of cost. It is run by the Government of Tamil Nadu and has undergraduate, postgraduate, and superspecialty medical courses in all the specialties. The various departments have been upgraded into full-fledged institutes of excellence. The Madras Institute of Neurology (MIN) is one of the earliest institutes under MMC and the second neurosciences department to be started in India.

» Brief History of Madras Medical College and Government General Hospital

The British East India Company started the Government General Hospital, Chennai, in 1664, soon after the founding of the city of Madras (Chennai) in 1639. In 1835, the medical school attached to the general hospital was started and soon became the MMC. In the same year, but a few months earlier, the first medical college was started in Calcutta. The first batch of students graduated in 1852. In 1857, the MMC was affiliated to the University of Madras and soon became a center of excellence imparting training in all the medical and surgical specialties. It is now one of the premier institutions in the country with undergraduate, postgraduate, and superspecialty courses. The courses offered by the MMC are affiliated to the Dr. MGR Medical University in Tamil Nadu from 1988. The Government General Hospital with around 3000 beds, which is attached to MMC, has all specialty and superspecialty departments in medicine and surgery with state-of--the-art facilities, and caters to the needs of public without levying any expenses on the patients.

» History of Madras Institute of Neurology

Dr. B. Ramamurthi, after his return from Newcastle, UK, in 1950, after undergoing training in neurosurgery under Professor G. F. Rowbotham, started the Department of Neurosurgery in the Government General Hospital on the auspicious Vijayadasami day (October 1950), with a few beds in the general surgical ward. The department was expanded later. Dr. S. T. Narasimhan, who had been trained in the United States, and had brought the first EEG machine to Chennai, joined Dr. Ramamurthi in the department. Cerebral angiography was introduced in 1952, with the joining of Dr. K. M. Pillai and Dr. M. G. Varadharajan, the neuroradiologists. Dr. V. Rajagopal, after undergoing training in neuroanesthesia in the United Kingdom, joined the department in 1953. Dr. S. Balaparameswara Rao joined the department as the first neurosurgery trainee and holds the unique distinction of starting neurosurgery departments at Vishakhapatnam and Hyderabad. Dr. V. Balasubramaniam, who was a brilliant surgeon, as well as Dr. M. Natarajan, subsequently became a part of the department. Dr. G. Arjundas joined the department as the first neurologist in 1957 after undergoing neurology training at Queen's Square, London. Dr. S. Kalyanaraman, after his neurosurgical training under Prof. Norman Dott and Prof. Gillingham at Edinburgh, also joined the department. The neurology division got strengthened further by Dr. K. Jagannathan, who joined in 1962 after neurology training at the Queen's Square, London. After that, the department came to be called as the Department of Neurology and Neurosurgery.

Stereotactic surgery was started in the department after the 3-week visit by Dr. Lawrence Walsh and Dr. Denis Williams from Queen's Square, London, in 1960. Leksell's stereotactic machine was installed in 1962 [Figure 3],[Figure 4],[Figure 5],[Figure 6],[Figure 7]. M.S. (Neurosurgery) program affiliated to the University of Madras was started in 1959, and Dr. V. Balasubramaniam was the first candidate for the program, qualifying in 1961. Later, the nomenclature was changed to M. Ch. (Neurosurgery). D.M. (Neurology) was also started in 1966, and Dr. Krishnamoorthy Srinivas, who joined the department after neurology training in the United Kingdom, was the first candidate. Dr. T. S. Kanaka, who joined the department, became the first Asian woman neurosurgeon to qualify in 1968. The neurosurgical team of Drs. V. Balasubramaniam, S. Kalyanaraman and T. S. Kanaka, led by Dr. B. Ramamurthi, and supported well by their neurology counterparts, Drs. G. Arjundas and K. Jagannathan, pioneered the technique of stereotactic surgery. A large number of stereotactic procedures for involuntary movements, behavioral disorders, psychiatric disorders, epilepsy, and spasticity were performed, and many papers were published. Madras soon became a center of international acclaim in stereotactic surgery. In 15 years, more than 1700 stereotactic operations were performed in Madras, and lesions were placed in almost every important part of the brain. The department was further strengthened with the joining of the neurologist, Dr. Zaheer Ahmed Sayeed, after his training in Canada, as well as Dr. K. Valmikinathan, the neurochemist, after his training in the United Kingdom with Professor Cummins. In 1967, a separate head injury ward was started, which was the first of its kind in the country to exclusively deal with head injuries. Neuropathology was also added with the arrival of Dr. Sarasabharathi.

Figure 3: General Surgical Unit of Dr. Sangham Lal in 1951 (Dr. B. Ramamurthi was posted as a neurosurgeon in this unit on his return from the United Kingdom)

Influenced by the Montreal Neurological Institute during his visit there for training under Prof. Wilder Penfield, it was Prof. B. Ramamurthi's dream to start a similar institute in Madras that housed all the branches of neurosciences under one roof. Mr. C. N. Annadurai, the Chief Minister of Tamil Nadu, laid the foundation stone for the construction of the MIN in 1968. The project was completed in around 4 years, with part contribution from Dr. Achanta Lakshmipathi, the father-in-law of Prof. B. Ramamurthi. The MIN was declared open in 1972 by the President of India, His Excellency Mr. V. V. Giri, in the presence of the Governor, Mr. K. K. Shah, and the Chief Minister, Mr. M. Karunanidhi [Figure 8],[Figure 9],[Figure 10],[Figure 11],[Figure 12],[Figure 13],[Figure 14],[Figure 15]. The 25th anniversary celebrations of the MIN in 1975 were a grand success and were attended by more than 120 foreign neurologists and neurosurgeons [Figure 15],[Figure 16],[Figure 17],[Figure 18],[Figure 19],[Figure 20],[Figure 21]. A special issue of Neurology India was brought out on the occasion, which was a well-documented compilation of the clinical and research work done at the MIN. The MIN was acknowledged as a center of excellence in stereotactic surgery and clinical neurology, and many trainees from all over the country visited the MIN and underwent training. Dr. B. S. Virudhagirinathan, the clinical neuropsychologist, who also had his training in the United Kingdom, strengthened the department by his presence. After the retirement of Dr. B. Ramamurthi in January 1978, Dr. P. Narendran, who had already started the Department of Neurosurgery at the Stanley Medical College, took over as the Head of MIN. Prof. P. Narendran started microneurosurgery at the MIN in 1979, with the arrival of Zeiss operating microscope. In 1980, the Chief Minister Mr. M. G. Ramachandran commissioned a CT scan in the MIN. This was only the second CT scan in a government institution in the country (after the one setup at the AIIMS, Delhi) and the first to be started by a state government. CO2 laser, ultrasonic suction aspirator, and a machine to monitor evoked potentials were commissioned at the institute. Neuro-ophthalmology and Speech Therapy wings were also added to the institute. In 1984, Dr. P. Narendran and Dr. K. Logamuthukrishnan organized an international conference and workshop on intracranial pressure, which was a landmark event. After the retirement of Dr. P. Narendran, Dr. K. Jagannathan was appointed the Head of MIN. Subsequently, Dr. S. Kalyanaraman became the Head of MIN, and during his tenure, the 40th anniversary celebrations of the MIN in 1990 were marked by an intense academic activity, with monthly symposia and seminars in neurology and neurosurgery. The CT head scan was replaced by a new whole-body CT scan. Dr. C. U. Velmurugendran became the Head of the department after the retirement of Dr. Kalyanaraman, and during his tenure, the 1993 Annual Conference of the Neurological Society of India (NSI) and the 1997 Annual Conference of the Indian Academy of Neurology were hosted by the MIN at Chennai. Several specialty clinics, namely the epilepsy clinic, the headache clinic, and the movement disorder clinic, were started. 1999 was marked by 12 protocol seminars in neurology. Dr. R. Gajendran, Dr. K. Chellappan, and Dr. M. Mohan Sampath Kumar became successive Heads of MIN. The year 2000 saw the golden jubilee celebrations of the MIN, which was presided over by Dr. B. Ramamurthi in the presence of Chief Minister Mr. M. Karunanidhi [Figure 20]. The culmination of these celebrations occurred with the Annual Conference of NSI at Chennai in the year 2000. The subsequent years saw the upgradation of the facilities including the starting of a new head injury intensive care unit with state-of-the-art facilities, an air-conditioned library and a computer center.

Figure 14: Plaque showing the inauguration of Madras Institute of Neurology in 1972 by Honorable President of India, Mr. V. V. Giri, in the presence of the Governor, Mr. K. K. Shah, and the Chief Minister, Mr. M. Karunanidhi

The MIN has seen a steady growth in the facilities and academic activity keeping with the times. The successive Heads of the department, MIN—Dr. Kamakshi Shanbogue, Dr. Geetha Lakshmipathy, Dr. A. V. Srinivasan, Dr. V. Natarajan, Dr. V. Sundar, Dr. K. Deiveegan, and Dr. K. Maheshwar—have all contributed to the academic growth and improvement of facilities at the MIN, upholding the glorious traditions of the institute. The Annual Conference of the Neurotrauma Society of India was hosted by the MIN in 2010. Recent years have seen the addition of two more high-end operating microscopes, craniotomes and drills, new ultrasonic suction aspirators, neuroendoscopic sets, new stereotactic surgery equipment, separate stroke ward with facilities for thrombolysis for acute stroke, plasmapheresis, botox injection, computerized EEG, video EEG, ENMG, EMG, VEMP, P300, new evoked potential equipment, polysomnography, and transcranial Doppler. TROPICON 2014, the Annual Conference of Tropical Neurology Subsection of Indian Academy of Neurology (IAN), was conducted by the MIN. The 16th Joint Annual Conference of Indian Epilepsy Association and Indian Epilepsy Society was organized at Chennai in February 2015, with the faculty of Institute of Neurology, MMC, playing an active part. A vocational training program for women with epilepsy has been started in 2014. Over the years, several batches of D.M. (Neurology) and M. Ch. (Neurosurgery) students have passed out from the MIN, and many Ph.D. scholars have also qualified from this institute.

Owing to the enormous increase in the clinical burden, associated with a commensurate increase in the strength of the faculty and students in neurology and neurosurgery, the government bifurcated the MIN into the Institute of Neurology in late 2014 and the Institute of Neurosurgery in early 2015, to improve the administration of the institute. Dr. K. Bhanu took over as the first Director of the Institute of Neurology, and Dr. Ranganathan Jothi took over as the first Director of the Institute of Neurosurgery under the MMC. However, both the Institute of Neurology and the Institute of Neurosurgery are continuing the old tradition of combined academic activity and interaction among the faculty members of neurology and neurosurgery. The combined weekly Wednesday clinical meetings, journal clubs, and grand rounds are being continued as before in the glorious traditions of the MIN.

The MIN has several firsts in the country

Starting of stereotactic surgery,

Being the first comprehensive neurosciences institute with all neuroscience specialties under one roof,

First D.M. (Neurology) course,

First CT scan in the state government institute and second in a government institute in the whole country,

Highest number of neurologists (199 D.M. so far) and neurosurgeons (142 M. Ch. so far) to quality, and

Presently, the Neurology wing has five neurology units. The D.M. (Neurology) course has an annual intake of 14 students. There are also five scholars enrolled for Ph.D. (Neurology). The Neurology wing has state-of-the-art facilities including a stroke ward with facilities for thrombolysis for acute stroke, plasmapheresis, botox injection, computerized EEG, video EEG, ENMG, EMG, VEMP, P300, latest evoked potential equipment, polysomnography machine, and transcranial Doppler. There are regular presentations of papers at the annual conferences of the IAN and other neurology conferences, and publications in journals.

Neurosurgery

The Neurosurgery wing has 6 neurosurgical units. The M. Ch. (Neurosurgery) course has an annual intake of nine students for the 3-year program and two for the 6-year program. There are two Ph.D. scholars in neurosurgery. There is an exclusive neurosurgical operation theater complex with four tables for elective surgery, and one exclusive emergency operating table. There are three operating microscopes, including two latest high-end microscopes, craniotomes with drills, ultrasound suction aspirators, neuroendoscopes, latest MRI, compatible stereotactic apparatus, and C-arm image intensifier. There are regular presentations at the annual conferences of NSI and other neurosurgical conferences as well as publications in journals.

The Neuroradiology facilities include four CT scanners and two (including 3-tesla) MRI scanners and a facility for digital subtraction angiography. The Neuropathology and Neurochemistry wings have also been updated.

The regular Neurology–Neurosurgery combined weekly programs, including the Wednesday morning clinical meetings and Friday morning grand rounds are held regularly, as had been the trend in the early days of the MIN. The other combined activities include the medical audit meetings and journal clubs. Periodical symposia, seminars and invited lectures are a regular feature. There are a number of orations instituted in the names of previous teachers, which are delivered by eminent neuroscientists from India and abroad.

» Vision for the Future

Neurology

Owing to the increase in patient load and increase in the number of trainees, more space is required. Hence, it is proposed to have a separate multistoried block for neurology, with the latest amenities and a state-of-the-art library.

Neurosurgery

The neurosurgical patient load is also increasing with the preexisting space constraint. There is a proposal to expand the building, with wider space and more floors. There are plans to develop subspeciality units in neurosurgery, a separate endovascular neurosurgical facility, and facilities for epilepsy surgery and deep brain stimulation.

Acknowledgments

The authors express their heartfelt thanks to Dr. M. C. Vasudevan, Dr. K. Shyam Sundar of Voluntary Health Services Hospital, Chennai, and Dr. K. Sridhar of Global Hospitals, Chennai, for providing some of the rare historical photographs of the MIN.